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TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf

Wyoming rates for HCPCS L0455

Thoracic-lumbar-sacral orthosis (TLSO), flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf

Rates data updated October 2026.

How much does TLSO, Flexible, Sacrococcygeal to T-9, Off-the-Shelf cost?

$166

Typical negotiated rate. In Wyoming, October 2026.

Insurers have agreed to pay about $166 for this service. Most negotiated rates run $166 to $204.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $275 · 10th to 90th $219 to $275Professionalmedian $166 · 10th to 90th $166 to $219
$100$200facility $275professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Aetna
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$218.78
Typical High
$218.78
BCBS Wyoming
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Cigna
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
United
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$186.21
Typical High
$208.93

Where Wyoming sits

The same service costs 2.6 times more in Hawaii than in Utah. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wyoming· 50th of 51

$166

HI $417UT $162

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.